Anything is possibleQuote:
Originally Posted by Dan Druff
That would have been an especially disturbing conversation, given that the doctor was female.Quote:
Originally Posted by Cerveza Fria
Printable View
Anything is possibleQuote:
Originally Posted by Dan DruffThat would have been an especially disturbing conversation, given that the doctor was female.Quote:
Originally Posted by Cerveza Fria
Never did I think I'd feel so relieved to read a wall of text about Druff's rectum.
Glad you got it taken care of sir.
Hope all continues to be all right.
Actually, we didn’t read anything about Druff’s rectum. His colon, sure. But nothng about the passage to colon.Quote:
Originally Posted by Walter Sobchak
Plus, if Druff had a precancerous anything on his rectum in such an examination, he’d be crapping “Oh-Shit!” bricks all over this thread given the much higher mortality rate for such a diagnosis.
https://healthblog.uofmhealth.org/ca...-cancer-differ
[QUOTE=Dan Druff;957710]Asian by chance?Quote:
Originally Posted by Cerveza Fria
Don't know if you'd had one or you're just assuming it's terrible, but the covid nose test is no biggy. I found it to be painless. Just don't flinch.Quote:
Originally Posted by Dan Druff
The Doctor Office StaffQuote:
Originally Posted by Dan Druff
"You mean the guy that has been calling us about Gatorade colors is gone until 2024??
https://resources.nurse.com/image/2848408.1519245329000 "
Jennifer Tilly approves.
https://twitter.com/JenniferTilly/st...69997245575168
Faster test results than expected.
The polyps have been analyzed:
- The big (1.5 cm) one was a "tubulovillous adenoma" - precancerous, medium risk
- One of the small ones was also a "tubulovillous adenoma" - precancerous, medium risk
- One of the small ones was a "tubular adenoma" - precancerous, moderate risk
- One of the small ones was hyperplastic (benign) - benign
No cancer was detected in the polyps.
Looks like I will be going every 3 years for the rest of my life.
He knows his shitQuote:
Originally Posted by tgullThe Doctor Office StaffQuote:
Originally Posted by Dan Druff
"You mean the guy that has been calling us about Gatorade colors is gone until 2024??
https://resources.nurse.com/image/2848408.1519245329000 "
Totally tubular dudeQuote:
Originally Posted by Dan Druff
Consider this leak plugged.
BUMP
Normally I wouldn't post about my insurance billing follies unless it was really egregious, but this information might help others here save some Jew Gold if you get a colonoscopy and try to charge you.
Basically, most insurance companies have taken the position that a colonoscopy is "free" to the patient, as it's considered preventative. However, there are various ways you can get fucked by this, and will receive a bill anyway. It's important to know what you can do about this. I'm currently battling this out, and am most of the way there regarding success.
Here are the places where you might get billed:
1) The initial doctor's visit where they discuss the procedure and ask you if you have any questions. This can be billed as a specialist office visit. It shouldn't. This should be "preventative", and therefore free to you. I got billed $65 for this.
2) The colonoscopy itself requires various outpatient services to make it happen, such as nursing services, equipment, etc. It's sometimes called "ambulatory services". This should be included as part of the preventative care. For some reason, I got billed $231 for this.
3) If polyps are found, this can change the colonoscopy to be "diagnostic" rather than "preventative". This is stupid, because the removal of polyps IS the preventative part! If nothing is found, then it's not preventative, because there's nothing being prevented! So they have it backwards. For this reason, I was charged $40 for the colonoscopy, and $155 for the removal and analysis of the polyps.
4) If you elected to have them use propofol to put you out, you can be billed up to $200 for it, as some insurances consider this unnecessary and voluntary. I disagree, but what I think about it doesn't matter for this discussion. Anyway, the $200 is legit, and you have to pay it. Strangely enough, the propofol WAS covered for me. While I was hit with those four bullshit charges mentioned above, the one potentially legit charge was actually covered! If you do end up wit the $200 charge for the propofol, you can still attempt to call up your insurance and argue it out. Make sure you get a rep in the US, and ask for a supervisor if the initial US rep refuses to help you. Be polite but firm. Your best bet is to argue that you have anxiety, and need the propofol for the procedure.
I got the $231, $40, and $155 removed. I had to speak to US reps with my insurance company, who took care of it after listening to my points. They initially tried to argue, but they backed down quickly. You should be able to argue all of these off, by insisting that you were told the colonoscopies are free to the patient, and that a colonoscopy itself is always preventative -- that finding and removing polyps IS prevention!
The last part I'm dealing with is the $65 charged for the first visit (see #1 above), and that seems to be a billing code issue. I am semi-optimistic that I will prevail there, as well. The one problem is that I paid it back in November, before realizing that this shouldn't have been charged, so that's made it a bit more challenging. I'm in the right here, but will give up fighting it if it takes too long, because it's 4 months ago, and I already paid, so it's a lot harder to get fixed at this point.
This brings me to my final point. Do not pay ANY of these bills until you are satisfied that it has been adjusted properly. This puts the power in your hands.
Anyway, this is all occurring as a side effect to Obamacare. This is because Obamacare forces insurance companies to cover "preventative" care 100%, and the definition of "preventative" is rather loose, so these problems occur. Often these are arbitrary coding decisions made by the biller at the doctor's office, and you can get it reversed just by calling and pleading your case to the insurance company. Even if you don't have Obamacare, this all applies. I'm just telling you the origins of the problem with the colonoscopy billing.
But definitely dig in your heels and refuse to pay for anything except the propofol.
If you are under 50, make sure they know you have a family history, so the "preventative" part kicks in. For me, that's the truth anyway.
Great info Druff. Unfortunately I have some experience dealing with medical billing and it can be infuriating. Like Druff did, the number one thing is to deal with it immediately. I have had very small amounts I was unaware of all of a sudden show up through a collection agency. You call them and they don’t even know where the charge originated from. So the bottom line is to be on top of shit like Druff was.
I will say that I don’t believe that the medical billing personnel is in most cases sitting in front of the computer and trying to find loopholes in Obamacare or the Insurance Policy to squeeze every penny out of you. In my experience it seems like they don’t communicate well in many cases with the other staff, go along at their own pace and by and large just don’t have the expertise to interpret the law & insurance policies they should. If they had that kind of expertise they would make a hell of a lot more as an underwriter. So bottom line...things get fucked up.
As a rule they will almost always over charge you. I can’t remember every being undercharged for a procedure. That surely is by design and a number of people do over pay for one reason or another. It is a boring subject in general but I’m glad Druff took the time to break it down. It can save you even more significant money when the procedure is not “ambulatory” and requires a hospital stay.
"Normally I wouldn't post about my insurance billing follies" - lol what?! I feel like you've made dozens of posts over the years about navigating medical bills. Are you saying that you've had many other low-to-moderately-egregious medical insurance follies that you're not posting about?Quote:
Originally Posted by Dan Druff
It's truly baffling how unnecessarily complex the American health care system is and yet you'd prefer it over Canada's dreaded "socialized medicine" in which every citizen doesn't need to be a fucking actuary to understand what they should be paying for medical care.
Every time I see these threads on PFA I shake my head in wonder that your system is accepted as normal in the U.S.
Since I don't have a job, I have individual health insurance that I pay for myself. Starting March of this year, I was forced on one of the new Obamacare failplans. The cost of my insurance went from $172/mo to $255/mo, despite nearly identical benefits. Or so I thought.Quote:
Originally Posted by The ShrinkQuote:
Originally Posted by Dan Druff
"Normally I wouldn't post about my insurance billing follies" - lol what?! I feel like you've made dozens of posts over the years about navigating medical bills. Are you saying that you've had many other low-to-moderately-egregious medical insurance follies that you're not posting about?
This past week, I needed to see an opthalmologist, due to some strange pain in my left eye. It did not seem serious enough to go to the ER, but something I wanted to have checked out.
I looked up doctors on my insurance company's website. I found a large opthalmology office in my area where all of the doctors took my insurance.
I called the doctor's office and made an appointment. I verified that they took my insurance.
I got there on Monday afternoon, only to find out the bad news: They didn't actually take my insurance, because I had an individual plan. Basically they were not taking anyone on an individual plan, regardless of the insurance company.
I called up another opthalmology group in the area. Same story.
In fact, every office I called would not take my insurance!
I called the insurance company to inquire what was going on. How was it possible that these doctors were listed, yet when I got there, they didn't take my insurance?
What was I getting for my $255/mo?
I was told that all doctors had an option to terminate the contract with the insurance company at any time, and that the IT people weren't fast enough to update all of the offices that had dropped out. Apparently there has been a mass exodus from taking these individual plans.
But why?
Apparently these individual plans pay shit to the doctors, so most doctors are rejecting them, figuring that they will focus on the patients with employer-based insurance, which still pays them well.
And why does employer-based insurance pay better? Because the premiums are very high, so they can afford it. Individual plans only worked in the pre-Obamacare days because they could deny coverage to people with expensive pre-existing conditions. Now that they have to take everyone, there's basically no money left in the system to pay doctors the market rate, so they dramatically lowered what they pay, and doctors are dropping these plans like hotcakes.
Of course, the insurance company doesn't tell you this until you show up to the doctor's office and get the bad news.
And it's impossible to do a search for doctors who ARE covered, as these websites are not accurate. Even the phone reps cannot tell you, as they have the same flawed info as you.
Thanks Obama.Quote:
Originally Posted by tgullSince I don't have a job, I have individual health insurance that I pay for myself. Starting March of this year, I was forced on one of the new Obamacare failplans. The cost of my insurance went from $172/mo to $255/mo, despite nearly identical benefits. Or so I thought.Quote:
Originally Posted by The Shrink
This past week, I needed to see an opthalmologist, due to some strange pain in my left eye. It did not seem serious enough to go to the ER, but something I wanted to have checked out.
I looked up doctors on my insurance company's website. I found a large opthalmology office in my area where all of the doctors took my insurance.
I called the doctor's office and made an appointment. I verified that they took my insurance.
I got there on Monday afternoon, only to find out the bad news: They didn't actually take my insurance, because I had an individual plan. Basically they were not taking anyone on an individual plan, regardless of the insurance company.
I called up another opthalmology group in the area. Same story.
In fact, every office I called would not take my insurance!
I called the insurance company to inquire what was going on. How was it possible that these doctors were listed, yet when I got there, they didn't take my insurance?
What was I getting for my $255/mo?
I was told that all doctors had an option to terminate the contract with the insurance company at any time, and that the IT people weren't fast enough to update all of the offices that had dropped out. Apparently there has been a mass exodus from taking these individual plans.
But why?
Apparently these individual plans pay shit to the doctors, so most doctors are rejecting them, figuring that they will focus on the patients with employer-based insurance, which still pays them well.
And why does employer-based insurance pay better? Because the premiums are very high, so they can afford it. Individual plans only worked in the pre-Obamacare days because they could deny coverage to people with expensive pre-existing conditions. Now that they have to take everyone, there's basically no money left in the system to pay doctors the market rate, so they dramatically lowered what they pay, and doctors are dropping these plans like hotcakes.
Of course, the insurance company doesn't tell you this until you show up to the doctor's office and get the bad news.
And it's impossible to do a search for doctors who ARE covered, as these websites are not accurate. Even the phone reps cannot tell you, as they have the same flawed info as you.
Maybe join a co op?
I mean, this is exactly what I'm talking about. The fact that you have to look up doctors who are covered by your insurance, shop around, deal with insurance companies, etc. - it's all so bizarre.Quote:
Originally Posted by tgull
:thisQuote:
Originally Posted by The Shrink"Normally I wouldn't post about my insurance billing follies" - lol what?! I feel like you've made dozens of posts over the years about navigating medical bills. Are you saying that you've had many other low-to-moderately-egregious medical insurance follies that you're not posting about?Quote:
Originally Posted by Dan Druff
It's truly baffling how unnecessarily complex the American health care system is and yet you'd prefer it over Canada's dreaded "socialized medicine" in which every citizen doesn't need to be a fucking actuary to understand what they should be paying for medical care.
Every time I see these threads on PFA I shake my head in wonder that your system is accepted as normal in the U.S.
I don't know what the answer is but you're right - our system is impossibly complex and stupid.
Sincerely commend Druff for always digging in and fleshing out the bullshit behind this.
I've started down this path before but always give up because I simply don't have the time to deal with it, which is likely by design. Gratefully have no health issues and only go in for my annual, but even understanding the billing behind simple blood work is obnoxious.
Simply adding my son onto my dental plan took me three hours of jumping around from rep to rep with Kaiser.
This is all accurate. I ran into this same BS when I signed up for an Obamacare-era plan in 2014, after my previous individual plan was terminated. ("If you like your plan, you can keep your plan!")Quote:
Originally Posted by tgullSince I don't have a job, I have individual health insurance that I pay for myself. Starting March of this year, I was forced on one of the new Obamacare failplans. The cost of my insurance went from $172/mo to $255/mo, despite nearly identical benefits. Or so I thought.Quote:
Originally Posted by The Shrink
This past week, I needed to see an opthalmologist, due to some strange pain in my left eye. It did not seem serious enough to go to the ER, but something I wanted to have checked out.
I looked up doctors on my insurance company's website. I found a large opthalmology office in my area where all of the doctors took my insurance.
I called the doctor's office and made an appointment. I verified that they took my insurance.
I got there on Monday afternoon, only to find out the bad news: They didn't actually take my insurance, because I had an individual plan. Basically they were not taking anyone on an individual plan, regardless of the insurance company.
I called up another opthalmology group in the area. Same story.
In fact, every office I called would not take my insurance!
I called the insurance company to inquire what was going on. How was it possible that these doctors were listed, yet when I got there, they didn't take my insurance?
What was I getting for my $255/mo?
I was told that all doctors had an option to terminate the contract with the insurance company at any time, and that the IT people weren't fast enough to update all of the offices that had dropped out. Apparently there has been a mass exodus from taking these individual plans.
But why?
Apparently these individual plans pay shit to the doctors, so most doctors are rejecting them, figuring that they will focus on the patients with employer-based insurance, which still pays them well.
And why does employer-based insurance pay better? Because the premiums are very high, so they can afford it. Individual plans only worked in the pre-Obamacare days because they could deny coverage to people with expensive pre-existing conditions. Now that they have to take everyone, there's basically no money left in the system to pay doctors the market rate, so they dramatically lowered what they pay, and doctors are dropping these plans like hotcakes.
Of course, the insurance company doesn't tell you this until you show up to the doctor's office and get the bad news.
And it's impossible to do a search for doctors who ARE covered, as these websites are not accurate. Even the phone reps cannot tell you, as they have the same flawed info as you.
Almost no doctors took my plan, and the few that did either had a tremendous backlog of patients and/or were poorly rated.
Keep in mind that, despite being a lifelong Republican, I was one of the few in my party who said we need to give Obamacare a chance, and how I felt reform was necessary to make all Americans eligible for insurance.
Well, they screwed it up big time. In fixing one problem (people being denied individual insurance due to preexisting conditions), they broke something else (individual insurance, which was reasonably priced and had access to almost all doctors).
Here's a recommendation: Switch insurance companies. For me that was huge. Not all companies are created equal when it comes to individual plans. It's not like I was signed up to a cut-rate insurance company. I was part of a well-respected, huge insurance operation, and they just had shit individual doctor coverage. I switched to another major company, and it was far better. I still run into plenty of doctors which don't take my insurance, but it's not nearly as bad.
There's a myth that buying a top-tier plan will get you more doctor access. That's totally false. Your network is the same whether you buy a bronze (lowest) plan or a platinum (highest) plan. The only difference is amount of coverage. Also, this decision isn't automatic. Some people think poorer people should always get bronze, and rich people should always get platinum. Not necessarily. You need to look at the coverage, the monthly cost, and what you're likely to need/use. I actually started out with bronze, but as those benefits degraded and the price became too close to silver, I moved up to silver. Then silver's price went way up and got close enough to gold, so I switched to gold. I don't see a need for platinum. All you're doing is paying a lot of extra to have slightly better coverage of the bill. In the long run, most people will lose money with platinum instead of gold. The big difference is between gold and silver, because typically gold plans have no deductible, whereas silver plans do.
Also, it sounds like you have a PPO, which is the right move. Do not succumb to the temptation to get an HMO. They're terrible. HMOs are notoriously frugal when it comes to authorizing tests and specialist visits, plus they're a pain in the ass because your primary care physician is a gatekeeper for everything. HMOs can save you money, but it's not worth it for anyone over 40. I know many people with HMO horror stories.
You are correct that the doctor list on the websites aren't always accurate. That's arguably the most tilting part of this whole thing. The best thing you can do is look at the website AND call the doctor's office. Make sure to specify that you have an ACA plan. Don't just mention the insurance company name, say the company name and that you have an ACA plan. Ask them again if they're sure. Sometimes you'll get a scrub who just says "Oh yeah we take that" without listening to the details, so you want them to say it twice. Typically the insurance company will cover it if their website is mistaken, as long as you take a screen shot, file an appeal, and send it to them.
Good luck.
Quote:
Originally Posted by The Shrink"Normally I wouldn't post about my insurance billing follies" - lol what?! I feel like you've made dozens of posts over the years about navigating medical bills. Are you saying that you've had many other low-to-moderately-egregious medical insurance follies that you're not posting about?Quote:
Originally Posted by Dan Druff
It's truly baffling how unnecessarily complex the American health care system is and yet you'd prefer it over Canada's dreaded "socialized medicine" in which every citizen doesn't need to be a fucking actuary to understand what they should be paying for medical care.
Every time I see these threads on PFA I shake my head in wonder that your system is accepted as normal in the U.S.
I have made numerous posts on this forum over the years criticizing the US billing system. It's insanely complex, opaque (there's no way for the consumer to know what he's buying before he buys it), and easily manipulated by healthcare providers to screw people. If you know your way around it like me, it's still a huge pain in the ass, but you can prevent yourself from getting fucked, after a lot of effort. However, very few Americans understand it to the level I do, and almost all of them get fucked by medical billing in some way or another. The saddest thing is when I see people -- many of whom aren't well off -- just throw up their hands and agree to a payment plan to pay down charges they shouldn't owe. They're talked into it with, "Well, I can bring it down to $100 per month", and people think, "Okay, I can handle that", because too many people live in the moment financially, rather than looking at the big picture. Really manipulative. I have helped a number of friends out with medical bill fiascos, especially the poorer ones who can't afford to pay them without real hardship.
Is all of this absurd? Yes.
Do I hate it? Yes.
Does it really suck that the US system operates this way? Yes.
However, that doesn't mean socialized medicine is the answer. It solves one problem (billing and affordability), but creates too many others. I don't want to wait 5 months to see a specialist or get tests. I don't want a primary care physician acting as a gatekeeper as to whether I CAN see a specialist or get tests. I don't want to wait 2-6 months to get looked at if I suspect cancer.
The US will be especially bad at adapting to a socialized system, because it wasn't built that way in the first place, and because the US already has a doctor shortage. Even if the US is brought to work like the UK's NHS, that would be a disasterous system which I hate.
For all of my criticism of the US insurance/billing system (which I feel needs major reform), I do love the fact that I can go directly to a specialist, see one within days (sometimes same day), and get whichever reasonable tests I want, without an idiotic approval process for the vast majority of them.
I've had some baffling Facebook discussions with people from the UK, who defend their system, but then have weird justifications for why the flaws are okay. "Well yes I can't see a specialist for 4-6 months, but if you're not dying, why is that such a big deal?"
:wtf2
Umm... that's a huge deal. Quality of life can go WAY down for issues which are non-life-threatening, treatable, but require a specialist's knowledge to diagnose and direct.
It's really one of these things where the tradeoff isn't worth it -- not just to me, but to the average American. Some people don't realize how awful it is to not be able to get tests and specialist visits when you want them. It's one of those things where you don't know what you've got, 'til it's gone.
https://www.youtube.com/watch?v=i28UEoLXVFQ
We need billing/insurance reform in healthcare, not socialized medicine. Unfortunately, neither party wants this at the moment, though Republicans have warmed to it.
That's right, for those essential services like hospitals, hydro and highways you want to know there is a private monopoly that exists to please their shareholders above all else.Quote:
Originally Posted by Dan DruffQuote:
Originally Posted by The Shrink
I have made numerous posts on this forum over the years criticizing the US billing system. It's insanely complex, opaque (there's no way for the consumer to know what he's buying before he buys it), and easily manipulated by healthcare providers to screw people. If you know your way around it like me, it's still a huge pain in the ass, but you can prevent yourself from getting fucked, after a lot of effort. However, very few Americans understand it to the level I do, and almost all of them get fucked by medical billing in some way or another. The saddest thing is when I see people -- many of whom aren't well off -- just throw up their hands and agree to a payment plan to pay down charges they shouldn't owe. They're talked into it with, "Well, I can bring it down to $100 per month", and people think, "Okay, I can handle that", because too many people live in the moment financially, rather than looking at the big picture. Really manipulative. I have helped a number of friends out with medical bill fiascos, especially the poorer ones who can't afford to pay them without real hardship.
Is all of this absurd? Yes.
Do I hate it? Yes.
Does it really suck that the US system operates this way? Yes.
However, that doesn't mean socialized medicine is the answer. It solves one problem (billing and affordability), but creates too many others. I don't want to wait 5 months to see a specialist or get tests. I don't want a primary care physician acting as a gatekeeper as to whether I CAN see a specialist or get tests. I don't want to wait 2-6 months to get looked at if I suspect cancer.
The US will be especially bad at adapting to a socialized system, because it wasn't built that way in the first place, and because the US already has a doctor shortage. Even if the US is brought to work like the UK's NHS, that would be a disasterous system which I hate.
For all of my criticism of the US insurance/billing system (which I feel needs major reform), I do love the fact that I can go directly to a specialist, see one within days (sometimes same day), and get whichever reasonable tests I want, without an idiotic approval process for the vast majority of them.
I've had some baffling Facebook discussions with people from the UK, who defend their system, but then have weird justifications for why the flaws are okay. "Well yes I can't see a specialist for 4-6 months, but if you're not dying, why is that such a big deal?"
Umm... that's a huge deal. Quality of life can go WAY down for issues which are non-life-threatening, treatable, but require a specialist's knowledge to diagnose and direct.
It's really one of these things where the tradeoff isn't worth it -- not just to me, but to the average American. Some people don't realize how awful it is to not be able to get tests and specialist visits when you want them. It's one of those things where you don't know what you've got, 'til it's gone.
We need billing/insurance reform in healthcare, not socialized medicine. Unfortunately, neither party wants this at the moment, though Republicans have warmed to it.
The problems you imagine with socialized medicine are kept in check with regulations much more so than private interests who have convinced everyone that their big bank accounts are simply a coincidence and to not trust the people you elect.
I successfully convinced the insurance to reduce my entire bill to...
ZERO POINT ZERO
This includes the $65 for that pointless first telemedicine visit in late October. I already paid that, but it will be refunded to me.
Big improvement from the nearly $500 they wanted from me.
:yes
Would have been nice if I had no polyps, though. That part still sucks.
I just took 4 5mg Dulcolax and I am about to start drinking 64oz mixture of Gatorade and MiraLAX. Procedure scheduled for 9:45am tomorrow morning. 41 years old, history of cologne issues in the family. Will report back.
:shockQuote:
Originally Posted by BartHanson
I used to laugh at people who got colonoscopies in their early 40s with family histories, but recent research shows that's actually the right thing to do, as strange as that sounds.
My girlfriend, brother, and sister all got colonoscopies in their early 40s due to family history. I did not. I waited until a hair before age 49 (too long), and had the alarming result of four polyps, with one being early-stage precancerous and small, and one being mid-stage precancerous and large! Oops.
While I ended up barely catching mine in time, obviously I waited far too long, given the slowness in both polyp growth and polyps transforming into cancer. It's likely the big one started to grow in my early or early-mid 40s.
Anyway, Bart is doing the right thing, despite only being 41. He's even doing the right (easy) prep.
I had a phone conversation with him yesterday where I gave him some tips on not getting screwed billing wise.
Given his age, it's very likely his will come out clear, but better safe than sorry. Good luck.
Good luck. You and Tuchman were my go to entertainment back 15 years ago when I actually had cancer and was getting colonoscopies every six months. Wife would go to sleep and I’d sit there until 4AM est watching that Mike dude who bankrolled the pit games with his mom dust off buy in after buy in. Barry whatever. Allen iirc? You’d take a few polyps for the games to be that good again.Quote:
Originally Posted by BartHanson
Quote:
Originally Posted by BCRGood luck. You and Tuchman were my go to entertainment back 15 years ago when I actually had cancer and was getting colonoscopies every six months. Wife would go to sleep and I’d sit there until 4AM est watching that Mike dude who bankrolled the pit games with his mom dust off buy in after buy in. Barry whatever. Allen iirc? You’d take a few polyps for the games to be that good again.Quote:
Originally Posted by BartHanson
Hahahah! I won money off of "Corporation Mike" in a Trump election bet this year. I had to chase his ass down to collect in California. He's a good dude though, he is opening a casino in Ventura as we speak.
Colonoscopy was easy. Relatively painless. Worst part was the "emptying" the day before. I'm still not close to regular. Only had to do the Miralax and Gatorade + magnesium citrate. Level of anesthesia was "deep sedation" one step down below general. Unconscious but with no tube down the throat. I haven’t talked to the doctor yet but the nurse said all was normal. Part of the reason why I did this at 41 was is there is a history in my family, and I was diagnosed with internal hemorrhoids when I was 20 years old. Occasional blood in the stool.
Druff, coincidentally, Khalwat is having a colonoscopy tomorrow: https://twitter.com/gaijinity/status...872159747?s=20
Druff took the time to talk out all the ins and outs with me the day before over the phone, which was very helpful and I am appreciative. Billing headache story to follow however.
Given your association with khalwat, I was shocked when he didn't know you were having a colonoscopy! I was sure that the two of you discussed it and both decided to go forward with it.
khalwat told me that my radio segment about it partially inspired him to do it. He has no family history and had a referral he hadn't acted on since last year, but my segment encouraged him to call and schedule the actual procedure, which takes place tomorrow. He's 50 but with no family history.
If they said yours was "normal", that probably means clear, but you want to talk to the doctor.
My doctor was the first person I saw when I woke up, but perhaps she was there to talk to me because I had those polyps.
Interesting that you aren't regular yet. That was one problem I didn't have. After the colonoscopy, I didn't have any further diarrhea. However, I had a lot of fatigue both the day of the procedure and the day after. Most people (including my dad) described the propofol sleep as "very relaxing" and "refreshing". I didn't feel that way. I woke up tired, and remained that way for 2 days.
I also had pain in the colon area which lasted about a week, but after 3 days it started decreasing. I have no permanent after-effects from it. Within a week, I felt the same way I did before the procedure. My pain was apparently uncommon.
Hope yours indeed was clear, Bart. Unfortunately, you're not out of the woods yet, as most people with polyps start getting them after 45.
I have insurance with Ambetter from Superior Health of Texas, on an HSA 201 Bronze plan with a $5800 deductible. Colonoscopies are covered as preventive care if you are over 50 years old according to their "Preventive Services Guide". According to this guide all ages are also covered IF patients are at "high risk for colorectal cancer due to a family history of physical factors." https://ambetter.superiorhealthplan....ntiveGuide.pdf
The gastroenterologist was well aware of the need to code this procedure as a screening (he even brought the idea up to me) as opposed to a diagnostic test. I spoke with the hospital and the codes used were Z80.0 CPT 45378. These are the correct codes for the screening version of this test. Because of my family history, I believe I should not owe any cost sharing.
Texas hospitals, however, do something a bit strange and I have seen it happen several times now. In advance, they will contact the patient's insurance company (on special provider line) to find out if the insurer claims that the patient will owe any cost sharing. In this case Ambetter informed the hospital that this procedure did not need a preauthorization but that I owed the cost because I had not met my deductible. The hospital informed me that they would absolutely not do the procedure if this money was not collected in advance. I spoke with several people at different levels of the hospital administration. Interestingly enough the hospital quoted me a pre negotiated rate of $1,080 vs $3500 cash rate.
I spent about 3 hours on the phone with Ambetter customer service yesterday to no avail. I confirmed that the correct screening codes were being used but they would not let me talk to their special provider line or talk with claims, because there was no claim, and the procedure did not need a preauthorization. So my option was to back out. However, I had already started the gutting process and concluded that nothing more could be done a day away from the procedure and I didn’t want to put it off. Druff will probably think I am nuts for doing so but I have confidence that if this truly is supposed be covered because of my family history that I can get the payment back, via the claims department. It might be a process where I will have to request the notes from the gastroenterologist to prove the family history. BTW the anesthesia charge was not taken in advance.
Interesting thread and thought I would chime in.
Firstly congratulations for getting this all resolved both physically and financially.
I often here stories about the costs of medicine/ treatment in the U.S and the pricing model and complexity just blows my mind.
Living in England I can say with 100% certainty that everything that occurred here would have been done totally free of charge and in a timely fashion on the NHS, in fact the idea of paying for it in itself seems absurd. The NHS is one of the great pillars of our social fabric and does a fantastic job despite all the pressures it is under, however, the point I am wishing to make is that we do not exclusively have the NHS and we do in fact have a private sector working alongside.
The private sector in particular excels in specialist scenarios and does provide a 'fast track' option for some surgeries but is seldom actually needed but does provide another option in conjunction with the NHS, even in the private sector the costs are massively lower compared to the U.S.
From what I understand even a basic prescription can cost a fortune whereas here we pay £ 9.15 for a prescription that is reduced to zero if you are financially poor, and if you have ongoing repeat prescriptions this is also often free of charge.
But I speak from within a country that has had a working NHS for over 70 years and I understand to incorporate a system similar in the U.S would be very tricky based on a whole host of different factors ranging from population , which is far more, the overall size of the country ( you have states bigger than my entire country ) and general mindset.
Anyway , what i'm getting at is the fact that if the U.S were able to incorporate a similar model to the UK then you 100% would look back and think 'how did we not do this sooner'
Once again congrats on the all clear
yep, gonna be a star on the world's tiniest screen tomorrow! :)Quote:
Originally Posted by Dan Druff
Man that "super bowel cleaner" shit is no joke.
nutty, the topic of the NHS is something that frequently comes up when I discuss socialized healthcare.Quote:
Originally Posted by nutty007
While I've never lived in the UK and don't have personal experience with the NHS, I hear wildly differing reports about it. Some, like yourself, seem to really like the NHS. Others detest it, and decry its slowness and refusal to authorize many tests and specialist visits.
However, the NHS' own website admits that it's an 18 week wait for specialists and tests: https://www.nhs.uk/nhs-services/hosp...es-in-england/
I also read a report from 2019 which said that the NHS has been routinely exceeding the 18-week wait time!
This isn't bad for colonoscopies (since they aren't urgent, and polyps cause no pain), but an 18+ week wait for a specialist and tests can be horrendous if you're suffering from a non-life-threatening issue which interferes with quality of life. This is a huge flaw in the NHS, and in socialized systems in general.
I experienced this exact complaint when I joined Facebook groups for my LPR condition in 2018. People with LPR in the UK complained that their GP (general practitioner) didn't even know what LPR was, and that they were denied referrals to ENT doctors. They were all denied endoscopies. They all expressed jealousy that their American counterparts could see ENTs within a week, and they could get whatever test they wanted. These weren't people trying to be political -- they just wanted to get better! It was very eye opening.
I will concede that the American medical billing system is a disaster, and needs MAJOR reform. Neither party seems interested in tackling this. Surprisingly, Trump actually had a minor interest in fixing this, and a little legislation was passed to improve things, but it wasn't nearly enough. But he was the first President to want to tackle this problem. Too many Democrats just want to push for socialized medicine, and too many Republicans just want to leave the system as-is (or roll back Obamacare). Both are incorrect.
I absolutely do NOT want a system where a gatekeeper decides whether I can see a specialist or get tests, nor do I want one with those kind of waits.
Bart,
I'm not going to be as critical of your decision to pay as you might think. You had an undesirable situation at that point -- either back out the appointment and battle with your insurance company (possibly for months) until you can get them to guarantee the hospital that it will be fully covered, or get the procedure and risk getting fucked on the back end (no pun intended). Both choices suck, but you had to make one.
As I said on the phone, while I'm not familiar with Texas healthcare, I am pretty sure I figured out why you were billed in advance.
Since you're 41 years old, the hospital suspected your insurance company will refuse to cover the procedure as preventative, and thus you will owe your part. They're afraid you'll refuse to pay at that point, so they collected the $1080 you're projected to owe (in the worst case scenario) up front. If you were over 50, I'm guessing they wouldn't have asked for a penny.
So, yes, the bright side is that you have a good chance of getting your insurance company to honor the claim after the fact, and pay you the money back. The downside is that you've lost all of your leverage. Once you've already paid, both the hospital and the insurance company are less likely to help you.
In general, I always advise people NOT to pay anything in advance to doctors/hospitals for anything except office copays. You have an incredible amount of leverage in medical billing when you're the one holding the money. As I mentioned on the phone, I've talked down a lot of unfair/bullshit/scammy/confusing medical bills simply by refusing to send a penny until they make it right. Since many people actually DO stiff doctors and hospitals for medical bills, they're always hungry to take ANY payment if you're willing to give it to them, which makes your negotiating position strong. Once they hold the money, they give you a big fat middle finger.
Definitely contact your insurance provider now and get the process going regarding the claim. Ask for a supervisor. Don't just let some first-level scrub on the phone direct it, as they are often wrong.
Also, they were correct that it didn't need a preauth (preauths are only for procedures which aren't covered at all unless authorized). It's just a matter of whether the procedure is preventative (zero patient responsibility) or diagnostic (you pay the negotiated rate, and it applies to your deductible). You want the former. Keep pressing until you get the entire $1080 back.
Quote:
Originally Posted by Dan Druffnutty, the topic of the NHS is something that frequently comes up when I discuss socialized healthcare.Quote:
Originally Posted by nutty007
While I've never lived in the UK and don't have personal experience with the NHS, I hear wildly differing reports about it. Some, like yourself, seem to really like the NHS. Others detest it, and decry its slowness and refusal to authorize many tests and specialist visits.
However, the NHS' own website admits that it's an 18 week wait for specialists and tests: https://www.nhs.uk/nhs-services/hosp...es-in-england/
I also read a report from 2019 which said that the NHS has been routinely exceeding the 18-week wait time!
This isn't bad for colonoscopies (since they aren't urgent, and polyps cause no pain), but an 18+ week wait for a specialist and tests can be horrendous if you're suffering from a non-life-threatening issue which interferes with quality of life. This is a huge flaw in the NHS, and in socialized systems in general.
I experienced this exact complaint when I joined Facebook groups for my LPR condition in 2018. People with LPR in the UK complained that their GP (general practitioner) didn't even know what LPR was, and that they were denied referrals to ENT doctors. They were all denied endoscopies. They all expressed jealousy that their American counterparts could see ENTs within a week, and they could get whatever test they wanted. These weren't people trying to be political -- they just wanted to get better! It was very eye opening.
I will concede that the American medical billing system is a disaster, and needs MAJOR reform. Neither party seems interested in tackling this. Surprisingly, Trump actually had a minor interest in fixing this, and a little legislation was passed to improve things, but it wasn't nearly enough. But he was the first President to want to tackle this problem. Too many Democrats just want to push for socialized medicine, and too many Republicans just want to leave the system as-is (or roll back Obamacare). Both are incorrect.
I absolutely do NOT want a system where a gatekeeper decides whether I can see a specialist or get tests, nor do I want one with those kind of waits.
I can only speak from my experience and others I know and you would be right in stating that it has flaws, this has been perpetuated by an increasing population and a need for other surgeries / experiences that never really occurred in any frequency a decade ago such as gender realignment or cosmetic procedures, this has put a strain on the system but rest assured if i am ill I will get seen and treated. We also have a part of the NHS that allows you to turn up for accidents and emergencies on the day and get seen, you may have a wait but this is seldom more than 6-8 hours in total.
Also as mentioned if you did have a more specialised requirement then you have the option to go Private where waiting times are pretty much eradicated, whilst many here sigh at the costs of some of these it is still a fraction of the costs compared to the U.S and like with all good systems this provides options and choices.
One thing for certain is we not have a system of gatekeepers and there are choices. The NHS is under immense strain at present , largely because of Covid but it has not buckled and is still performing. the fact that we finally pushed through Brexit has also meant that we have delivered over 30 million vaccinations ( about 37 people in every 100) compared to Europe which is struggling with about 10 million vaccinations / country on average.
But to summarise it's not perfect but I for one am very happy with it and rest assured if you ever make the journey 'across the pond' and suffered a serious illness you would be treated.
BUMP
Remember that billing issue I was telling you guys about?
Looks like the Rhode Island governor must read PFA.
Rhode Island just made it illegal for in-network insurers to charge for age 45+ colonoscopies. Basically the exact same thing which happened to me would be illegal in Rhode Island, which would protect those who are less knowledgeable about the insurance industry, and wouldn't know how to fight it (which is most people).
http://www.rilegislature.gov/pressre...e3e9&ID=371539
Also, apparently a device was just approved to identify precancerous polyps, rather than counting on the doctor catching all of them.
https://www.wired.com/story/ai-help-...-colon-cancer/
Polyps sometimes get missed during colonoscopies, especially if the doctor is tired or distracted. (This is one of many reasons to get them early in the morning, rather than at the end of the day.)
This AI device would automatically "see" dangerous looking polyps and alert the doctor to them.
I think there's a good chance they didn't miss any with me, because they spent 40 minutes inside my colon, whereas the average procedure takes 10-15 minutes. When I woke up, I thought, "There's no way it was 10-15 minutes, it feels like I've been sleeping at least an hour", and indeed I had been asleep for over an hour. I didn't understand where the time went, until I got home and saw that the procedure took 40 minutes.
Anyway, this device might be in use by the time I get my next one in 2024.
This is something I personally have never for the first 41 years of my life ever really overly thought about, or cared about.
Some might say that I kinda just lived life a little recklessly maybe but in my mind it wasn't being reckless. I was just being me, immune to certain things and possibilities ever happening maybe. Or situations that I didnt think would ever involve me maybe, I was blind to it all. Now it is all real as can be to me, and some of it is scary. Like Cancer, or the thought of actually having it for example. And for the first 41 years of my life I did breeze through it health wise, never had any issues, literally nothing, pretty much a beacon of clean health I guess. No diabetes, asthma, nothing so it wasn't anything I ever thought about maybe or focused on. Then last year happened, and for me that was a changing point. And now Medical things, and health things I realize how serious they are. And for me, I try not to worry about a bunch of maybe things, and focus on if I have to be worrying, worry about some actual, real things that may or may not be affecting me. I don't worry about the maybes, or what-if's myself but that's maybe just not how I am.
IDK but I defiantly know that I do now, have a much more real perspective of all this Medical stuff and me now, then ever in my life before. Last January so only about 15 months ago I got the real wake up and the hey, you aren't that special or different then anyone else wake-Up Call.
If you don't have a family history, you can probably wait until 50 to do this.Quote:
Originally Posted by garrett
I guess your wife didn't pull you away for a quickie during your prep like she did that time you were on radio and had to leave for a while lol.Quote:
Originally Posted by khalwatyep, gonna be a star on the world's tiniest screen tomorrow! :)Quote:
Originally Posted by Dan Druff
Man that "super bowel cleaner" shit is no joke.
Hope it went well.
Me and Mama got our Cologuard results today-both Negative. Just couldn't bring ourselves to colonoscopies cuz a friend of our died after having his intestine punctured. He suffered a horrible death. Wishing all those who have them a good outcome. We know it's rare occurance but.......
Just curious, was your friend's doctor sued for malpractice?Quote:
Originally Posted by IamGreek